=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023125960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAN GREENE PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 SOUTH STREET
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-6895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-445-8030
-----------------------------------------------------
Fax | 413-445-8033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 SOUTH STREET
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-6895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-445-8030
-----------------------------------------------------
Fax | 413-445-8033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST OWNER
-----------------------------------------------------
Name | JAN M GREENE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 413-445-8030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------